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Prediction of massive bleeding. Shock index and modified shock index
L J Terceros-Almanza1, C García-Fuentes1, S Bermejo-Aznárez1
1Unidad de Trauma y Emergencias, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, España.
Insights
The Shock Index and Modified Shock Index effectively predict massive bleeding in severe trauma patients. These simple tools can aid early assessment in trauma care.
Area of Science:
- Trauma Care
- Emergency Medicine
- Critical Care Medicine
Background:
- Massive bleeding is a critical complication in severe trauma.
- Early identification of patients at risk for massive hemorrhage is crucial for timely intervention.
- The Shock Index (SI) and Modified Shock Index (MSI) are potential early warning tools.
Purpose of the Study:
- To evaluate the predictive accuracy of the Shock Index and Modified Shock Index for massive bleeding in severe trauma patients.
- To determine the sensitivity, specificity, and area under the ROC curve (AUROC) for both indices.
Main Methods:
- Retrospective cohort study of severe trauma patients (Injury Severity Score >15) admitted to a tertiary hospital ICU.
- Analysis included calculation of sensitivity, specificity, predictive values, likelihood ratios, and ROC curves for SI and MSI.
- Data collected from January 2014 to December 2015.
Main Results:
- The study included 287 patients, with a massive bleeding rate of 8.71%.
- Shock Index showed an AUROC of 0.89 (95% CI: 0.84-0.94) with optimal cutoff 1.11, Se 91.3%, Sp 79.69%.
- Modified Shock Index demonstrated an AUROC of 0.90 (95% CI: 0.86-0.95) with optimal cutoff 1.46, Se 95.65%, Sp 75.78%.
Conclusions:
- Both Shock Index and Modified Shock Index are reliable predictors of massive bleeding in severe trauma.
- These indices can be readily integrated into the initial assessment of trauma patients.
- Their use may facilitate earlier detection and management of life-threatening hemorrhage.
Objective:
To determine the predictive value of the Shock Index and Modified Shock Index in patients with massive bleeding due to severe trauma.
Design:
Retrospective cohort.
Setting:
Severe trauma patient's initial attention at the intensive care unit of a tertiary hospital.
Subjects:
Patients older than 14 years that were admitted to the hospital with severe trauma (Injury Severity Score >15) form January 2014 to December 2015.
Variables:
We studied the sensitivity (Se), specificity (Sp), positive and negative predictive value (PV+ and PV-), positive and negative likelihood ratio (LR+ and LR-), ROC curves (Receiver Operating Characteristics) and the area under the same (AUROC) for prediction of massive hemorrhage.
Results:
287 patients were included, 76.31% (219) were male, mean age was 43,36 (±17.71) years and ISS was 26 (interquartile range [IQR]: 21-34). The overall frequency of massive bleeding was 8.71% (25). For Shock Index: AUROC was 0.89 (95% confidence intervals [CI] 0.84 to 0.94), with an optimal cutoff at 1.11, Se was 91.3% (95% CI: 73.2 to 97.58) and Sp was 79.69% (95% CI: 74.34 to 84.16). For the Modified Shock Index: AUROC was 0.90 (95% CI: 0.86 to 0.95), with an optimal cutoff at 1.46, Se was 95.65% (95% CI: 79.01 to 99.23) and Sp was 75.78% (95% CI: 70.18 to 80.62).
Conclusion:
Shock Index and Modified Shock Index are good predictors of massive bleeding and could be easily incorporated to the initial workup of patients with severe trauma.